Q. I am embarrassed by my extremely large breasts, but have heard that a breast reduction leaves bad scars. Is this true?
A. Anchor-shaped incisions that follow the natural contour of the breast often remain visible for up to a year and then will fade with time.
Q. My large, sagging breasts have always made me extremely self-conscious. Is breast reduction the answer?
A The decision to have any cosmetic surgery is always a personal one and should be considered carefully. Breast Reduction can often provide relief to women who have endured physical discomfort as well as emotional distress due to oversized breasts.
answers by Diane Gibby M.D. north dallas area plastic surgeon
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Friday, May 1, 2009
Breast Lift Questions and answers
Q. What can I do for sagging breasts?
A. An outpatient procedure called “mastopexy” can remove excess skin and tighten sagging skin on the lower half of the breasts. Sometimes an implant is used to fill out the lifted breast.
Q. Babies, breastfeeding and hitting the big 4-0 have taken a toll on my breasts. Is there a procedure that can reshape my sagging breasts?
A. An outpatient procedure called “mastopexy” can remove excess skin and tighten sagging skin. Sometimes an implant is used to fill out the lifted breast.
Answers by Dr. Diane Gibby, specializing in female plastic surgery, http://www.drgibby.com
Breast Questions
Q. Help! My baby is a year old and although I’ve lost all my pregnancy weight, my breasts sag and I still have a tummy. What are my options?
A. Pregnancy and breast-feeding often changes the shape of a woman’s body. If a consistent exercise program doesn’t achieve the desired results, there are several body-contouring procedures that can reshape the breasts and abdomen. The type of surgery best for you will depend on your age, size and skin elasticity.
A. Pregnancy and breast-feeding often changes the shape of a woman’s body. If a consistent exercise program doesn’t achieve the desired results, there are several body-contouring procedures that can reshape the breasts and abdomen. The type of surgery best for you will depend on your age, size and skin elasticity.
Q. Should I get a mammogram if I have breast implants?
A. Mammograms are critical in detecting cancer, and women over 40 with implants should have them yearly. Make sure your mammographer has experience imaging breasts with implants and knows the special views needed to screen for cancer.
Q. What is the advantage of using a textured breast implant as opposed to a smooth one?
A. Some studies show a decreased risk of scar tissue with textured implants. However, textured implants may increase the risk of visible rippling, particularly when implants are placed above the muscle or in women with very thin skin.
Q. How will I know if my breast implant has ruptured?
A. It is usually obvious when a saline implant ruptures because the breast will become smaller as the water in harmlessly absorbed. A ruptured silicone implant can be more difficult to detect and may require radiological tests, such as a sonogram or MRI.
Q. What is considered the best placement for breast implants, above or below the muscle?
A. Although once exclusively placed over the chest muscle, many doctors today prefer the “submuscular” approach. Where the implants are placed depends largely on the amount of existing breast tissue, breast shape, type of implant used and the desired end result.
Answers provided by richardson, wylie and plano area plastic surgeon, Diane Gibby M.D.
Breast Augmentation FAQ
Q. I’m worried about losing nipple sensation after Breast Augmentation.
A. While there is always a small risk of nipples becoming numb or oversensitive after breast surgery, usually any lost sensation is regained within 3 months.
A. While there is always a small risk of nipples becoming numb or oversensitive after breast surgery, usually any lost sensation is regained within 3 months.
Q. I am considering breast implants but am concerned about Capsular Contracture. What causes this condition and how common is it?
A. Virtually every body will respond to the presence of an implant by forming a capsule of scar tissue around the implant. In most cases the presence of this scar capsule is not detectable and the breasts look and feel very natural. In about 5 percent of patients, however, the capsule contracts around the implant causing the breast to feel hard and in some cases the shape of the breast will be distorted, often requiring additional surgery.
Q. I am considering a breast augmentation but am nervous about deciding on a flattering size and then conveying that decision to my doctor without any miscommunication. Any suggestions?
A. I suggest that my patients come to the office with photographs of the size breasts they wish to have, as well as pictures of breast sizes that they do not want. This helps eliminate all but a certain range of sizes and also give me a good visual idea of what my patient’s goals are for surgery.
Q. I am ready to schedule my breast augmentation, but am nervous about outpatient surgery. Is it safe?
A. It is important that the outpatient facility, including the physician’s office, is accredited to perform the type of surgery you are requesting. Ask for these credentials, including information about the person performing your anesthesia. At the Women’s Center, board certified anesthesiologists are involved with your surgical care.
Q. I am interested in having a breast augmentation before my beach vacation in three weeks. Will this allow for enough recovery time?
A. You may be tired or sore but should be up and around within 24 hours. While recovery time varies from patient to patient and depends largely on pre-surgery health, you should be fine to travel three weeks after surgery.
Q. Do breasts with implants experience sagging over time?
A. All breasts relax as time passes, because the weight stretches the skin, elasticity is lost with age and the amount of breast tissue often decreases as a woman get older. These factors mean that breasts can be expected to sag slightly whether or not there are implants present.
Answers provided by Diane Gibby, M.D. a specialist in plastic surgery in the DFW metroplex. http://www.drgibby.com
Thigh and arm lift FAQ
Central Body Lift
Q. Is there a procedure to get rid of loose skin on my rear and thighs?
A. A buttocks or thigh lift can eliminate excess skin but may leave long, visible scars. This is effective surgery, but should be used as a last resort after trying diet, exercise and even liposuction.
Q. Over the years I have lost and regained the same 25 pounds many times and now the skin on my thighs and buttocks has lost its tone and just “hangs”. Is there a procedure to correct this?
A. All tissue relaxes with time, and yo-yo dieting certainly contributes to this process. A Lower Body Lift will remove fat and tighten loose skin, which will result in more youthful contours.
Arm Lift
Q. Even in the summer I refuse to wear sleeveless tops because of the fat on the back of my upper arms. Is there a procedure that will get rid of this?
A. Thick or fatty upper arms can be a problematic area for many women. If diet and toning exercises have not helped, liposculpture can be performed to remove the fat on the upper arms.
Answers provided by a Dallas area female plastic surgeon, Dr. Diane Gibby, http://www.drgibby.com
Tummy tuck questions and answers
Tummy Tuck FAQ
Tummy Tuck
Q. My friend had liposuction performed on her stomach. Isn’t a tummy tuck the standard surgery for a “poochy” stomach?
A. Liposuction alone is performed when the underlying abdominal muscles and skin are fairly taut. A tummy tuck however, which can be done in conjunction with liposuction, tightens the skin and repairs weakened abdominal muscles.
Tummy Tuck
Q. My friend had liposuction performed on her stomach. Isn’t a tummy tuck the standard surgery for a “poochy” stomach?
A. Liposuction alone is performed when the underlying abdominal muscles and skin are fairly taut. A tummy tuck however, which can be done in conjunction with liposuction, tightens the skin and repairs weakened abdominal muscles.
Q. How soon can I have a tummy tuck after having a baby?
A. “Abdominoplasty” can be done as early as 6 weeks after pregnancy, but unless you have someone reliable to help with the baby, it’s best to wait 6 months to give your body time to recover from the pregnancy and delivery.
Q. I have always wanted to wear a bikini, but am self-conscious about my “poochy” stomach. Is getting a tummy tuck the answer?
A. If diet and exercise have not helped flatten your stomach, a tummy tuck can dramatically reduce the appearance of a protruding abdomen, giving you flatter and firmer stomach.
answers by Dr. Diane Gibby, http://www.drgibby.com
Liposuction questions and answers
Liposuction
Q. I’ve exercised most of my 50+ years, but I still have fat around my hips and thighs. Am I too old for liposuction?
A. Absolutely not! Women of all ages can benefit from liposuction. You may be a candidate for Ultrasonic liposuction that uses high-frequency sound waves to liquefy fat while minimizing bruising and blood loss.
Q. What exactly is cellulite and can liposuction get rid of it?
A. Cellulite is fat trapped close to the skin between tight, fibrous bands. While liposuction can improve contour, it cannot eliminate cellulite. In some cases liposuction may lessen the appearance of the dimpling.
Q. Can I expect to loose any weight after undergoing liposuction?
A. Liposuction is not meant for weight loss, but rather for reshaping the body by getting rid of stubborn and unappealing deposits of fat. The difference will be seen primarily in the way your clothes fit. You will, however, probably loose inches and look slimmer.
Q. Is there a way to keep fat from returning after liposuction?
A. The best way to maintain the results from liposuction is through proper health, nutrition and exercise. While fat cells won’t return once removed, they will increase in size if you gain weight after the procedure.
Q. I have always heard that fat won’t return to an area that has undergone liposuction, is this true?
A. The number of fat cells in the adult body is fairly constant. These cells swell or shrink depending on weight gain or loss. Once they are removed via liposuction they do not return, but the remaining fat cells can expand with a significant weight gain.
Q. What kind of anesthesia is generally used with liposuction?
A. They type of anesthesia that would best suit you, such as local, intravenous sedation, or general anesthesia, depends on the area to be suctioned as well as your thoughts about the method used. As always, safety and comfort are critical goals in this decision making process. Our board certified anesthesiologists can help you with your final decision.
Q. It’s summertime but I refuse to wear sleeveless tops because of the jiggly fat on the back of my upper arms. Can liposuction improve this area?
A. Thick or fatty upper arms can be a problematic area for many women. If diet and toning exercises have not helped, liposculpture can improve the contour of your upper arms.
Q. What kind of anesthesia is generally used with liposuction?
A. They type of anesthesia that would best suit you, such as local, intravenous sedation, or general anesthesia, depends on the area to be suctioned as well as your thoughts about the method used. As always, safety and comfort are critical goals in this decision making process. Our board certified anesthesiologists can help you with your final decision.
Q. I recently lost some weight and want to reward myself with liposuction to tackle those areas that I could not minimize with diet and exercise. I am concerned about staying motivated and maintaining my new figure. Any suggestions?
A. At the Women’s Center we offer post-op incentives such as complimentary sessions with a personal trainer or nutritionist. This encourages our patients to live a healthy lifestyle, which will contribute to maintaining or even improving their surgical results.
Answers provided by Dr. Diane Gibby, http://www.drgibby.com
Do female plastic surgeons have a better understanding of what women want?
IN THEIR SKIN/ or MORE THAN SKIN DEEP: Do female plastic surgeons have a better understanding of what women want?
Date: April 10, 2006 Author: Natasha Singer, THE NEW YORK TIMES
MIND & BODY Last June, after Jerri Hafizi, a 5-foot-3-inch construction firm executive, lost 65 pounds, she asked a plastic surgeon to tighten the loose skin around her torso and lift her breasts.
But the surgeon seemed not to understand what she wanted. He squeezed Hafizi's skin in his fists, she said, and told her that the only way to solve her problem was with implants.
"He wanted to make me into a Barbie doll," said Hafizi, 50, who lives in Merritt Island, Fla. "But I didn't want to be made over according to somebody else's idea of what a woman should look like."
A few days later, when Hafizi consulted Dr. Roxanne J. Guy, a plastic surgeon in Melbourne, Fla., she had a different experience. Guy spent more than an hour discussing Hafizi's choices. But most important, Hafizi said, "Dr. Guy was OK with the fact that I was going for the Rene Russo look, not the Pamela Anderson look."
The surgery Guy ultimately performed was implant-free and, in Hafizi's eyes, a success. And she thinks she knows why: "Dr. Guy was more empathetic and attentive to my expectations and goals because she's a woman."
Guy runs across this kind of thinking all the time.
"Female patients are drawn perhaps to the idea that they are going to get more time and empathy and understanding from a doctor who has the same female organs as they do," she said.
That view appears to be gaining traction in the world of plastic surgery, where there has been an influx of women in the last decade. Of 7,003 doctors in the United States who are board-certified in plastic surgery -- meaning they have passed examinations to demonstrate their competency -- just 623 are women, according to the American Board of Plastic Surgery. But that number is more than double what it was in 1995.
The idea that female surgeons might be more empathetic than men -- or that they might have significantly different standards of beauty - - is the subject of much debate. The suggestion of a gender gap among cosmetic surgeons, some say, is nothing more than a marketing ploy used by some practices to attract patients.
"People should go to a female plastic surgeon because she is a great doctor, not because she is selling sympathy and empathy and all that other nonsense," said Dr. Gerald Imber, a plastic surgeon in New York City who described himself as "notoriously unsympathetic" to patients. "I care about my patients, and my heart would break if something went wrong during surgery, but I am not selling empathy. I am offering excellence as a physician and a surgeon."
Women are far more likely than men to have plastic surgery. They accounted for 90 percent of the more than 2 million surgical procedures in the United States in 2005, according to statistics kept by the American Society for Aesthetic Plastic Surgery. And an increasing number of these women are specifically asking for female surgeons, said Guy, who is the first woman to be elected president of the American Society of Plastic Surgeons.
Dr. Linda Li, a plastic surgeon in Beverly Hills, said female doctors can offer a fresh point of view.
"Patients used to have two kinds of plastic surgeons to choose from," Li said, "an older professorial fatherlike figure who told you what he was going to do to you or a young attractive male whose attention made you feel attractive.
"But now there is a third choice, a female plastic surgeon like me who patients can relate to and bond with like a mom or a sister."
Women are entering medicine in greater numbers, now representing half the students at medical schools, according to the Project on Gender, Culture and Advancement in Academic Medicine at Brandeis.
Field attracts women
And as the training period for plastic surgeons has grown shorter, the specialty has become more attractive to young women who want both a career and a family.
For example, 30 years ago Dr. Helen S. Colen, a plastic surgeon in New York City, had to put in eight years as a medical resident: five years of general surgery followed by three years of special plastic surgery training.
Today her daughter, Dr. Kari L. Colen, 31, is in a combined six- year plastic surgery program at New York University School of Medicine. And the elder Colen said she went to greater lengths than her daughter to prove she could compete.
"I went into labor while I was operating at the hospital, finished up my surgery, delivered the baby, and immediately went back to work," Colen said. "Because you were the only female plastic surgery resident, you had to be exemplary."
The younger Colen, who recently had a baby, was able to use her month of annual vacation as maternity leave.
Listening skills differ
There is some evidence that male and female doctors communicate differently with their patients. For example, in 1994 researchers at Northeastern University in Boston observed doctors of both sexes during 100 patient visits and found that the women were more emotionally engaged and less domineering than the men.
And an analysis of data on more than 90,000 doctor's office visits nationwide from 1995 to 2000, conducted by researchers at the University of California, San Francisco, found that female physicians spent more time with patients.
Dr. Sydney R. Coleman, a plastic surgeon in New York City, said he hired a young woman as an associate in 2004 in order to better communicate with patients.
Now he often invites that woman, Dr. Alesia P. Saboeiro, to join in his consultations, to offer her opinion and to answer questions patients are too embarrassed to ask him, he said.
"I am a good listener," Coleman said. "But no matter how hard I try to get into the head of a woman, I am never going to understand her completely."
But Dr. Elizabeth J. Hall-Findlay, a plastic surgeon in Banff, Alberta, refutes the notion that female surgeons
The idea that men and women have different views on what constitutes an attractive female body is also hotly debated.
"A lot of male surgeons have a tendency to push bigger implants or think bigger is better," said Dr. Jane S. Weston, a plastic surgeon in Atherton. "Perhaps my breast aesthetic is different. I tend to go for a more genteel, shapely, natural look."
Attention to size matters
But others argue that it is the physician's ability to realize the patient's ideal and not the gender of the surgeon that matters.
"I do have patients who want their breasts made smaller because they feel their previous doctors made them too big, but that is not gender-related," said Dr. Mia Talmor, the first female plastic surgeon appointed to the full-time faculty of Weill Medical College of Cornell University in New York. "It's about whether the surgeon was meticulous and listened to the patient."
Shani Gonzales, 26, of New York City, said surgeons can be poor listeners. Gonzales consulted three plastic surgeons, all of them men, and told each one that she wanted to reduce her size 36J breasts to decrease her back pain and the self-consciousness she had felt since she was a teenager. But, she informed them, she still wanted cleavage.
"But all of the doctors just assumed I wanted to go from being superbig to super-small," said Gonzales, an assistant at a record company.
Each doctor showed her post-operative photographs of patients and their breasts, she said, but they all looked the same. "It was all very cookie cutter," she said.
So last month, after her mother urged her to find a female plastic surgeon, Gonzales went to see Dr. Nina Shaikh-Naidu. Shaikh-Naidu, who practices in New York, discussed at length Gonzales' aesthetic goal and her concern that surgery might diminish breast sensation or her ability to one day breast feed.
Shaikh-Naidu recently performed the surgery, and Gonzales said she has been holding "viewings" to show friends her new size 36D breasts.
"I keep wondering whether Dr. Naidu was more sensitive to what I wanted and more able to give it to me because she's a woman who has breasts herself," Gonzales said. "But maybe she's just a better doctor."
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